Gastrectomy Instrument Set: Stomach Surgery Instruments Guide

The word “gastrectomy” hides three quite different operations, and the instrument tray changes with each. Before the set is built, the scrub team needs to know which one is on the board.

A cancer resection and a bariatric sleeve share almost no instruments beyond the basic laparotomy or laparoscopy backbone. This guide breaks the stomach surgery set into its functional parts and flags where the three procedures diverge, so a procurement lead can specify gastrectomy instruments that match the actual caseload rather than a generic pack.

The Open Gastric Resection Set

An open total or subtotal gastrectomy is upper-abdominal surgery at its most demanding. The stomach sits high under the costal margin, and reaching the oesophageal hiatus for a total resection means holding the liver and diaphragm out of a deep field.

Retraction

Fixed, self-retaining retraction is the difference between a controlled operation and a fight. An upper-hand or Bookwalter frame with a liver blade lifts the left lobe off the stomach, while Balfour and Deaver retractors manage the lateral walls. For the deep hiatal dissection in a total gastrectomy, long narrow blades are essential.

• Bookwalter or Thompson upper-abdominal frame with liver retractor
• Balfour self-retaining retractor
• Deaver retractors, 2.5 cm and 5 cm, for the hiatus
• Harrington sweetheart retractor for the liver edge

Our Bookwalter system guide covers configuring a ring for upper-abdominal work.

Gastric and Bowel Clamps

Controlling the stomach and jejunum without crushing the tissue that will form the anastomosis is the core skill. Non-crushing intestinal clamps (Doyen pattern) occlude the bowel atraumatically; crushing clamps (Payr, Kocher) secure the specimen side, which is being discarded. A generous supply of Rochester-Pean and Kelly haemostats controls the rich gastric blood supply along both curvatures.

• Doyen non-crushing intestinal clamps, straight and curved
• Payr crushing (pylorus) clamp for the specimen side
• Kocher toothed clamps for tough tissue
• Rochester-Pean and Kelly haemostats, 18+ per tray
• Right-angle Mixter forceps for the left gastric pedicle

Dissection and Anastomosis

Long Metzenbaum scissors handle the omental and pedicle dissection; Mayo scissors take the tougher planes. The reconstruction — whether a Billroth anastomosis or a Roux-en-Y — needs fine tissue forceps, long needle holders, and Allis and Babcock forceps to present the bowel. Many teams staple the anastomosis; the open tray still carries the hand-sewn backup.

• Long curved Metzenbaum scissors, 23 cm
• Mayo-Hegar needle holders, 20 cm, TC insert
• Allis and Babcock tissue forceps
• DeBakey atraumatic forceps for handling bowel edges
• Linear and circular staplers with appropriate reloads

The Laparoscopic Sleeve Gastrectomy Set

Bariatric surgery is almost entirely stapled and laparoscopic, so the tray looks completely different. There is no anastomosis in a sleeve — the greater curvature is simply stapled off along a calibrating bougie.

• Bariatric-length trocars, 5 mm, 12 mm, and 15 mm
• Long shafted graspers: bowel, Yohan, Babcock patterns
• Maryland dissector and laparoscopic curved scissors, 45 cm
• Liver retractor (Nathanson or fan)
• Endoscopic linear stapler with green/black reloads
• Calibrating bougie (36–40 Fr) to size the sleeve
• Suction-irrigation cannula

The instrument architecture mirrors other advanced laparoscopic sets — the same backbone described in our cholecystectomy instrument set guide, lengthened for the bariatric patient. As always, a full open conversion tray stays sterile and reachable.

Vessel Control and Lymphadenectomy

A gastrectomy for cancer is as much a lymph node dissection as a resection. The stomach draws blood from the left and right gastric, left and right gastroepiploic, and short gastric vessels, and a proper oncologic clearance (a D2 lymphadenectomy) follows those vessels to their origins. That means the tray must handle vessel control along both curvatures and around the coeliac axis.

Right-angle Mixter forceps pass ties behind the left gastric pedicle; fine Lahey and tonsil forceps carry ligatures around the shorter, more fragile vessels. Many teams seal the gastroepiploic arcade and short gastrics with an energy device, but the open tray still needs enough haemostats and right-angle clamps to control the named vessels by hand if the energy platform fails. A vessel loop or two helps sling the splenic vessels out of harm during a total gastrectomy, where the tail of the pancreas and spleen sit close to the field.

For the specimen extraction and the deep hiatal exposure of a total resection, the same principles as other upper-GI sets apply — controlled retraction, long instruments, and an anastomosis group ready before the stomach is divided.

Care, Counting, and Reprocessing

Doyen bowel clamps carry long, thin, flexible blades that warp if mishandled; a bent blade no longer occludes evenly and becomes a spillage risk, so inspect them at every reprocessing cycle. Autoclave ratcheted clamps on the first ratchet only to spare the box joint. The rich vascular field of a gastrectomy generates many haemostats, so count them meticulously — small clamps are the classic retained item in upper-abdominal surgery. Ultrasonic-clean and lubricate the Mixter and needle-holder hinges; dried protein stiffens the action and shortens the instrument’s life.

Materials That Survive Gastric Surgery

Gastric contents are acidic, and the field is wet with irrigation. Corrosion resistance matters. We forge clamp bodies and retractors from AISI 410 and 420 martensitic stainless, hardened so the jaws hold their set; scissor edges run 420 for edge retention. Doyen and DeBakey jaws and other atraumatic tips that meet bowel and gastric mucosa are made from austenitic 316L for maximum pitting resistance, and needle holders carry brazed tungsten carbide inserts. Every instrument is passivated, laser-marked for traceability, produced under ISO 13485, and CE marked under EU MDR, with steel to ISO 7153-1.

Know the operation, and the tray builds itself: deep retraction and bowel clamps for a resection, staplers and a bougie for a sleeve. Explore our full surgical instrument catalogue or contact us for a gastric set matched to your surgeons’ technique.